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Neutrophil-to-lymphocyte ratio as a predictor for cardiovascular diseases: a cohort study in Tianjin, China
Yuxin Zhao1,2, Shuaixiang Zhang1,2, Yue Yi1,2
1Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.
Insights
Higher neutrophils-to-lymphocyte ratio (NLR) is linked to increased cardiovascular disease (CVD) risk. This study found elevated NLR significantly associated with higher incidence of CVDs, myocardial infarction, and ischemic stroke.
Area of Science:
- Cardiology
- Inflammation Research
- Epidemiology
Background:
- The neutrophils-to-lymphocyte ratio (NLR) is an emerging inflammatory marker.
- Elevated NLR has been implicated in various cardiovascular diseases (CVDs).
- Understanding the association between NLR and CVD risk in diverse populations is crucial.
Purpose of the Study:
- To investigate the relationship between baseline neutrophils-to-lymphocyte ratio (NLR) and the incidence of cardiovascular diseases (CVDs).
- To evaluate NLR as a predictive marker for total CVDs, myocardial infarction, and ischemic stroke.
Main Methods:
- A prospective cohort study involving 4667 participants over 40 years old, free of CVDs at baseline.
- NLR values were assessed at baseline and analyzed using Cox proportional hazards models.
- Confounding factors were adjusted using LASSO regression.
Main Results:
- A total of 150 CVD events occurred during 13,691 person-years of follow-up.
- Higher baseline NLR tertiles showed a significant trend towards increased CVD incidence (p=0.019).
- Adjusted Cox models indicated NLR (continuous) was associated with increased risk of total CVDs (HR 1.10), myocardial infarction (HR 1.12), and ischemic stroke (HR 1.21). Participants in the highest NLR tertile had significantly higher risks for CVDs and myocardial infarction compared to the lowest tertile.
Conclusions:
- Elevated neutrophils-to-lymphocyte ratio is a significant independent predictor of cardiovascular disease risk.
- NLR may serve as a valuable, easily accessible biomarker for stratifying CVD risk in clinical practice.
- Further research should explore the underlying mechanisms linking NLR to cardiovascular events.
Abstract:
Based on a cohort in Tianjin, China, we explore the relationship between neutrophils-to-lymphocyte ratio (NLR) and the risk of cardiovascular diseases (CVDs). From January 2010 to December 2019, 4667 eligible participants aged more than 40 years old, CVDs-free, and registered in two community health service centers were recruited and followed up. The values of NLR collected at baseline were included in Cox proportional hazards model to evaluate its association with the incidence risk of CVDs. Hazard ratio (HR) and 95% confidence interval (CI) were calculated before and after adjustment for potential confounding factors selected by LASSO regression. During a total of 13,691 person-years of follow-up among all participants (median, 2.0 years; interquartile range, 1.7-2.5), 150 (3.42%) newly diagnosed CVDs events occurred, with the incidence density of CVDs of 10.96/1000 person-year. The incidence density in subgroups categorized by tertiles of baseline NLR was 8.08/1000, 11.74/1000, and 13.24/1000, respectively (p trend = 0.019). COX models revealed that after adjustment for potential confounders, NLR (as a continuous variable) was significantly related to the risk of total CVDs (HR 1.10, 95% CI: 1.04, 1.17), myocardial infarction (HR 1.12, 95% CI: 1.05, 1.20), and ischemic stroke (HR 1.21, 95% CI: 1.10, 1.33). When NLR was categorized into tertiles, participants in the top tertile had a significantly higher risk of CVDs (HR 1.61, 95% CI: 1.06, 2.44) and myocardial infarction (HR 1.88, 95% CI: 1.09, 3.27) relative to those in the bottom tertile.
